Monitoring baby during labor, options...

[Woodland]

This will be my first labor where I am actually monitored. I have a 3 year old and my last labor experience was at home, I had no monitoring as my midwife unfortuantely didnt show up and because of meconium in my waters when my water broke as I started pushing I transfered to the hospital. I had my little guy pretty much right after I arrived, so I didnt get any monitoring whatsoever. So, this time around I decided to labor and birth at a birth center about 45 min away from my house. Because of the distance and their friendliness toward natural birth, I am planning to get there early enough to actually labor there and spend some time in their labor tubs.

I realized I will be monitored this time and I am curious what others experience with this is. What I know is that the band contains a wireless device and it will intermitedly (sp?) monitor the babies heart rate. I am not very thrilled with this option for a few reasons, 1. I dont know how comfortable the band will be and 2. I watched my friend have her baby wearing the band, and because the baby descended rapidly the band "lost" the babies heart rate and therefore they rushed her to push the baby out, which could be the reason she got a big hematoma that pained her for weeks after birth and she tore as well, but who knows...

So, I asked my OB today what she thought of the band and if I could just have a doppler check every so often and she said its the birth center policy to wear the wireless belly band and not up to her. So after my appointment I called my doula/sister and she said yes its their policy but its is my right and I always have the option to refuse anything I dont want. Which is why I am now posting this thread. This birth center is very natural birth friendly and because I have never been monitored I am not sure if I am thinking too much about this issue.

After reading Henci Goer's Thinking womans guide to birth, I started thinking about monitoring, and how the false positives cause a lot of problems, and because I saw what occurred with my friends birth, it made me question the necessity of this band. So, I would love some input on this subject. Thanks!!!!

[lovebeingamomma]

if it's policy, and of course you have the right to refuse...but I wonder if they can refuse you the option of using the doppler. Their way or the high way in other words. So you really just need to talk to the birth center and let them know your situation. Otherwise...a wireless band is a lot better then being strapped down to a bed!

[AlexisT]

The problem is that telemetry monitoring is still EFM, with all that entails. How are they actually going to run the strip? If they have it on the whole time, the temptation is going to be to run the strip the whole time. Also, the belts slip. And when they slip, they make you lie still so they can get a reading.

Don't get me wrong; if I had to have continuous monitoring (which I, personally, do need to have) I would prefer telemetry to wired; but if I were a low risk woman, I would prefer neither.

On the flip side, the issue with asking for Doppler is that if the facility requires all women to be on the monitors, the nurses probably don't have a lot of experience with monitoring via Doppler. A midwife might be willing to do IA personally, but an OB won't--you're stuck with the nurses' usual protocols.

[MegBoz]

Well, I too had no monitoring in labor, but just because it went fast & I hadn't even left the house when I felt the urge to push!
We went to the hospital & I pushed DS out there, but a nurse HELD the monitor thing in place on my belly while I pushed, so no belt! That was nice, it didn't bother me in the least. actually there were so many people rushing around, since I arrived pushing, I honestly barely noticed her.

They didn't lose a signal. Although, sheesh, I would hope they're smart enough to realize that if baby's HR goes from 100 BPM down to 0, that doesn't actually mean his heart has outright stopped! Maybe holding the monitor & moving it around as necessary helps prevent losing the signal? While my DS' HR did drop a bit - enough for my MW to ask me to get down on my left side instead of H&K & for the nurses to give me some oxygen, they didnt' lose the signal, so far as I know.

I have worn the bands for NSTs in the hospital since DS went past 41W. I hate hate HATE anything even remotely tight around my mid-section. I wear all my pants sorta lose & hanging from my hips, so I was worried about that too. But it is very stretchy, soft, & adjustable material. I didn't find it uncomfortable in the least. (Of course, I was just sitting there for NST, not in labor.)

My hospital's policy was to monitor about 20 min every hour. I don't think there's anything wrong with monitoring - it is continuous EFM that leads to the 'false positive' (higher CS rate, higher intervention rate without improved outcomes.) So I would be very wary of continuous monitoring. Have you toured the BC? Maybe that's "official policy" but nurses are more than happy to oblidge if you request intermittent. That was the case with my MWs on some policies - official hospital policy was induce at 42W & you can drink clear fluids in labor, but no eating. One MW flat out told me she disagrees with this & I should go ahead & disobey! LOVE HER!

[kcparker]

With DS1, I had continuous EFM when I had cervidil placed, but after it fell out, they went to intermittent monitoring with a handheld doppler every 30 min. or so, then every other cxn. during pushing. I found the belly band very annoying because it was constricting and I wanted to be naked, and it slipped a lot because I didn't want to stay still, so the nurse was constantly futzing with it to find the baby's heartbeat again. At one point, I snapped at her, "This is getting really annoying." The doppler was less annoying in terms of tactile stimulation, but I really disliked the static sound when they were looking for the heartbeat. During pushing, I was more focused on pushing and didn't notice the monitoring much.

With DS2, labor was so fast that the midwives tried to monitor me when they arrived, and tried once in the tub. I think they only got the doppler near me twice, and I am not sure they heard much. But if labor is going that fast, generally everything is good with the baby.

I would advise taking in some research that shows that continuous EFM is does not provide better outcomes compared to intermittent monitoring and ask WHY they want continuous EFM. If they do intermittent anyway (though I have never heard of a telemetry unit that just takes readings every X minutes), and the band is just so a nurse doesn't have to come hold a doppler on your belly, ask if you can do doppler monitoring by having your partner hold it on instead. Discuss their reasons and feel out your options (i.e. informed refusal and working with the HCPs instead of fighting with them in labor) ahead of time, and hopefully you can find a balance between your desire to labor free of wires and bands and their desire to know how the baby is tolerating labor.

[Adamsmama]

I've worn the band during all 3 of my labors. I didn't mind it ... if the h/b got lost they found it again by moving the belt around. If I wanted to get out of bed, I could walk around without it -- I think they wanted it monitored at least 1x an hour.

[bailefeliz]

At my facility, once we obtain a reactive non stress test, the monitoring units can come off and we move to intermittent auscultation with the doppler if there are no high risk factors. Then we auscultate before, during, and after a contraction every 30 minutes in active labor. We only reapply the continuous monitor (telemetry or otherwise) if there are concerns from fetal assessment. To be honest, I rarely hear complaints about the belly band/belts when women are able to be up and moving.

Wishing you the best!

[rparker]

My first birth was a hospital birth. I had an initial 20 minutes of external EFM (non-telemetry, so I had to sit on a bed). I then had intermittent auscultation with a handheld doppler 2-3(?) times. I pushed in a semi-sitting position on a bed (mistake) at which point I again had the external EFM for my 20 minute or so pushing stage. So I had about 40 minutes of EFM during the 3 hours from triage to baby.

I'm having this next baby in a (different) hospital. I am not consenting to EFM if this pregnancy progresses as normally as my first. My HCP (family practice M.D.) is onboard with this. I have agreed to intermittent auscultation with either a handheld doppler or stethoscope. ACOG actually has guidelines outlining how this should be done and establishing it as an acceptable "alternative protocol." (Not sure yet if I'm going to agree to monitoring as frequently as ACOG recommends, but I'm a lousy patient.)

My reasoning is that last time the intermittent EFM made my contractions painful. The nurse holding a doppler against my skin did not make the contractions painful. I dislike pain I have no experience with telemetry EFM (it is an option at this hospital, but my doctor didn't push it) but my guess is that it might be easy to get false positives with it if you're "too mobile" and the bands slip?

You can refuse any intervention in a hospital. The worst the staff can do is make you sign something saying that you're going against medical advice. It might be more complicated in a freestanding birth center and/or an ABC unit because they could refuse to take you as a patient and transfer your care to a traditional L&D unit where they are legally obligated to provide you with care (no matter how much you go AMA) if you are in labor. Hope that helps!

[smpayne]

A L/D nurse I know, was complaining about the new wireless monitors the hospital was insisting they just had to have. She said that in order for it to stay on a "mobile" mom, the band has to be so tight that the mom's usualy complain that it hurts and it ends up being taken off or it just slips and then it is useless.

Personally having the EFM strapped to me annoyed the crap out of me.

[AlexisT]

Originally Posted by MegBoz

My hospital's policy was to monitor about 20 min every hour. I don't think there's anything wrong with monitoring - it is continuous EFM that leads to the 'false positive' (higher CS rate, higher intervention rate without improved outcomes.) So I would be very wary of continuous monitoring. Have you toured the BC? Maybe that's "official policy" but nurses are more than happy to oblidge if you request intermittent.

The problem is, intermittent EFM often doesn't stay that way. Running a strip means they can see a "problem" (sometimes real sometimes not) and then they keep running the strip, and there you go. 20 minutes an hour is "continuous" in some ways. You still get the strip and the attendant problems with interpretation.

If they see the heartbeat go, of course they adjust the monitor. And then when you move and they lose it again, they tell you to stay still. I was in the hospital for monitoring and had to lie flat on my back for over an hour because every time I moved, the belts slipped. Now, frankly, the midwife should have done a better job with getting the belts tight rather than making me lie still, because it was miserable. But then the strip went bad, and I HAD to lie there still. In my case, it was medically necessary, but I wouldn't want to go through it if it weren't.

[moonjunio]

This is one of the reasons I want to birth at home this time. A minor part of the big picture for me, but I think that monitoring in general keeps your brain in an analysis mode, I.e. Keeps you and your attendants doing "labor math" which interrupts the flow of things. Same thing with all the dilation checks, it is sooo discouraging to hear you've only gone 1 more cm over however many hours. That's when the drug thoughts are hard to resist.

As monitoring goes, wireless is "ok" in terms of comfort, I was able to roam and use all the equipment I wanted but getting it adjusted after slips was very annoying and definitely gets you out of the flow.

[Lucy&Jude'sMama]

I was just going to post a question about how to get around this hospital policy. At the hospital I had my daughter at you could have intermittent monitoring, but even that I found to be extremely annoying and painful. When I was in early labor it was no big deal because my contractions weren't very painful. However once the real stuff got going I was laboring in the tub (you could labor in the tub but not give birth in it) and I would be semi-comfortable and getting in the right state of mind... Then a nurse would come in and demand that I get out of the tub to be monitored... Every hour for 15 minutes!

OMG! I hated it and I hated them every time they did this to me. It felt like torture. Finally I got a nice nurse who found a hand held Doppler and started monitoring me that way. That's not as bad, but I still found it annoying. I just really wanted to be left alone. I hated all the poking and prodding that happened while I was at the hospital. I had an unmediated hospital birth but I really felt like I had to fight for it the entire time I was there... which was 20 hours! First baby so I stupidly thought she was going to be born with in hours of my water breaking! Hahaha Oh the things I will do differently this time around!!

[PoppyMama]

I had my first two wearing that stupid band and then my third at a very lowtech birth center with the apprentice midwife using the doppler every once in a while. I preferred that SO MUCH over the band.

[Quinalla]

For me, the EFM being strapped to me didn't bother me (though it probably needed to be tighter, but my labor was so fast they didn't bother), but them futzing with it after nearly every contraction was annoying. If they had tried messing with it during a contraction, I would have put a stop to that I finally started moving the damn thing myself to keep it working so they wouldn't have to mess with it. So if you can avoid it, I would as it is just one more thing, but at least for me it was not a huge deal.